Has The Health Care Industry Lost Its Moral Compass?

Medicine is filled with good people doing the best they can to operate in a bad system. In my experience, most people in the health care industry are doing their jobs well. They just don’t realize that their job descriptions are just plain wrong.

In the U.S., we spend 2.7 trillion dollars per year on health care. Elsewhere, the average health care expenditure is $3,000 per person per year. In the U.S., it’s $8,000 per person per year. We spend more than $300 billion per year on pharmaceuticals, almost as much as the whole rest of the world combined. Yet our life expectancy is ranked at #50 in world. 49 countries are more successful at living long healthy lives than we are, and they do it at a lesser cost to boot.

Dartmouth University even did a study examining regional differences in how much it costs to care for a Medicare patient. They found that Medicare patients in Miami averaged a cost of $15,000 per patient per year, whereas Medicare patients in Minneapolis averaged about $7,000 per patient per year. The patients in Miami were getting significantly more medical care, and many more Medicare dollars were spent, yet the Miami patients did not have better outcomes and actually were more likely to die sooner than the Minneapolis patients.

20% of patients take up 80% of health care dollars, usually from chronic illness, repetitive hospitalization, and morbid obesity, yet this increased spending of health care dollars doesn’t improve the life expectancy of these patients.

Not Health Care – Disease Care

I blame our system for going about it all wrong. As Andrew Weil said in the documentary film Escape Fire, “We don’t have a health care system. We have a disease care system.”

There’s no incentive in the way the system is set up to prevent disease. Doctors don’t get paid if they spend an hour teaching you how to eat a healthy diet, exercise regularly, prevent work stress, alleviate loneliness, invest in healthy relationships, and focus on positive belief.

The reality is that our for-profit health care system is set up to reward physicians who order tests or do procedures, not the ones who spend time talking to their patients. And yet talking to patients is the #1 best thing a physician can do if he or she really cares about helping patients heal.

If a cardiologist spends 5 minutes with you and then puts a stent in your heart, he gets paid about $1500. If he spends 45 min talking about preventative health, he gets paid about $15. This fee-for-service model the U.S. has embraced rewards physicians for delivering more care – for ordering more tests and performing more procedures, which leads to overdiagnosis and overtreatment, when the best thing we could do is reward physicians who devote themselves to helping patients live optimally healthy lives so they can avoid lab tests and procedures.

The Risks Of Overdiagnosis & Overtreatment

According to a 2011 study, 30% of health care dollars are wasted and don’t improve outcomes. And it’s not just that medical dollars get wasted. Such overdiagnosis and overtreatment can do immeasurable harm.

187,000 patients die each year from harmful health care, defined as medical error and nosocomial infections acquired within the hospital, often the result of infection from drug-resistant bacterial strains that exist only in hospitals. While modern medicine, especially in the realm of trauma care, saves lives that would have been lost a century ago, the reality is that modern medical care is the 3rd leading cause of death, just after heart disease (#1) and cancer (#2.)

Our health care system is seriously broken. Yet, those in power do not want the system to be fixed. Most of the money in health care dollars is going into the hands of medical device companies, HMO’s, and pharmaceutical companies, not doctors or hospitals. These companies have powerful lobbies and big budgets to ensure that Congress doesn’t enact laws that limit their power and profits.

For example, we all know that a nutritious diet is essential to good health. As Hippocrates said, “Let food be your medicine and medicine be your food.” Yet, our government subsidizes all the wrong things – grains and corn, not carrots, beets, and kale. Imagine if low income people could get cheap organic produce! How much easier it would be for poor families to drink green juice and eat salad.

What Happened To Our Integrity?

When medicine became a for-profit business and we decided that good health was a privilege, not a human right, we lost our moral compass. Insurance companies don’t care about patient outcomes. They care about profits and are legally obligated to bow to their investors on Wall Street. And pharmaceutical companies don’t care about helping people heal – they care about making money so their stock goes up.

As described in Escape Fire, Steven Nissan MD was doing a Google search about Avandia, a 3-4 billion dollar drug for diabetes, and he discovered that, in the clinical trials for Avandia, there were more heart attacks in the Avandia group – a 30% increase, in fact. Yet the company failed to disclose to the FDA, the physicians, or the patients that taking Avandia would increase heart attack risk by 30%. The leading cause of death in patients with diabetes is heart disease, so having a widely-prescribed diabetes drug that increases heart attacks by nearly 1/3 is a public health catastrophe. Yet through some crazy twist of politics, the drug got fast tracked through FDA approval, and in 2006, Avandia was the #1 selling diabetes drug until someone finally got wind of the study results and blew the whistle. The company settled a lawsuit for $3 billion.

When Will We Start Doing The Right Thing?

Lobbyists are ruling health care in Washington, mastering spin to scare people into voting against their own self interests. They’re so masterful and it’s so stealth that you may have just done this in the last election without even knowing it.

Yet things must change. Dr. Dean Ornish said, “We spend so much time in medicine mopping up the floor around the sink that’s overflowing without turning off the faucet.”

It’s time to turn off the faucet and stop the hemorrhage that’s bleeding health care of its heart. The solution is not more tests, more drugs, or more procedures. The solution requires physicians to spend more time with patients engaged in the art of healing and educating patients not just about diet, exercise, getting enough sleep, and taking your vitamins, but also the other factors I’ve included in my radical new wellness model the Whole Health Cairn. To be wholly healthy, you need to do more than care for your physical body. It’s also essential to be healthy in your relationships, your work life, your creative life, your spiritual life, your sex life, your financial life, your environment, and your mental health.

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As an advocate for my patients to receive holistic health care services, especially when a large part of my patient demographic suffers from chronic pain, this is a very timely and well written article. I am sharing it with my students I teach in integrative medicine, as well as my patients. Knowledge is power…and a catalyst, for change.

I absolutely agree with you Lissa…there currently isn’t a Health Care system it’s a Disease Care system. So grateful there are people like you who are shifting this around!!! I think the best thing we can do for the next generation and those that come after is to focus on prevention!

Wendy Merron

Lissa, I share the same sentiments, but feel frustrated. What can one person do? Our system isn’t working and I pray that it improves. Today I found that I may need to have a sleep study done. Maybe even two. And each are about $2,000 each.
needless to say that I’m looking into alternative methods to take care of apnea.

saraholeary

I am so with you on this one! Thank you for doing this work! Thank you for not burning out and getting cynical about it all! As a physician you are in a powerful position to instigate change. It’s a huge ship to turn around but together we can do it! It’s a out maintenance and prevention, not disease.

oneill@olympus.net

I have been reading about the overdiagnosis and excessive treatment of children with psychoactive drugs that are leading to their deaths and apparently may play a part in a number of the mass killings in which youngsters kill others.
One is:
How Psychiatric Drugs Can Kill Your Child – Documentary Video
by rosaryfilms-you can google it. It is heart-wrenching.
The other is: “The TRUE SOURCE of RANDOM & MASS SHOOTINGS and VIOLENCE” which can also be googled. Discussions must contain investigation into these allegations and reports.
Thank you for your efforts to create a sane health system. The one we have is broken in so very many ways.

blueeyegravy

While I am with you, I feel sympathy for my friends and family who look at me with disbelief that I can do more to help myself than a doctor giving me meds. When I insist on healthy, organic as-much-as-possible food, barley green, exericse, peace, they shake their head. I helped my son overcome OCD and Tourettes and at 15, many say they could never tell he suffered with it. I learned how food, lifestyle habits as described above, are entwined and vital to life. But until people BELIEVE they can help themselves, they won’t. I feel like Dr. Oz is making some great headway here, and since he is saying it, more are believing it. I appreciate your viewpoints.

Diane

Don’t ever give up Lissa…..the tides are turning slowly. Understanding what gets in the way of change is so important. Supporting the mental health it takes to maintain most physical health is essential.

Suzi

Thank you. I appreciate you discussing a very delicate topic in a very honest and realistic manner. I am a clinical pharmacist who has spent many years medicating our communities and not improving anyone’s health. My goal and purpose was to help people and at the end of the day, I help numb and bandaid the problems in our society without any real long term outcome except a contribution to our ailing society, health care and debt which is only continuing to degrade and slide into a deep dark abyss. I work with Medicare and Medicaid and the I can tell you it will only get worse if we continue the path we are headed down. It is frightening and the common individual is completely oblivious. God bless you for your efforts. Our country desperately needs you.

How refreshing! Thank you for all your work, Lissa. As a lactation consultant (BA-IBCLC), postpartum doula and HypnoBirthing childbirth educator, my life is also dedicated to holistic health and empowering new and expectant parents with the information and resources they need to understand ALL their options – not just the ones presented to them by the doctors their insurance company pays.

Blessings to you this Christmas!

Mlongyear

Great article. I completely agree. Our healthcare system is too reactive in caring for problems that are already there. We need to move towards a more proactive healthcare system and prevent disease before it sets in. As a student in chiropractic school the first thing that we learn is to look at the whole patient and all of the things that could be effecting their health, like relationships and ability to handle the stresses on them and their body. However the current accepted healthcare paradigm looks only at symptoms and prescribing things that mask those symptoms. That is the reason that spending more money on health care is actually decreasing our lifespan. Those symptoms are your bodies way of telling you that there is a problem and you need to change what you are doing. If you mask those with drugs and go on living the way you were it just continues to make you less healthy. The problem though is that the doctors and pharmaceutical companies are only giving people what they want. To change things we need to change the perspective of the public to become more proactive and less reactive about their health. The old adage of “if it isn’t broke don’t fix it” doesn’t hold true when dealin with our bodies. We also need to put down some of the technologies we have become so dependent on. It is sad to walk around and see people’s heads buried in their smartphone or tablet, completely missing out on the “human” interactions that will help to strengthen our minds and improve our mental health. Family and face to face interaction is quickly becoming a thing of the past. We need to slow down and enjoy those around us on a daily basis.

Hali Karla

As a recovering RN, and an artist, I am a big fan… praying and seeking ways myself to advocate for and help meet holistic, self-empowering healing needs for individuals outside of the framework and fear of our current healthcare system. You are an inspiration. Thank you.